401k Plan data: UNIVERSITY SETTLEMENT OF NEW YORK LIFE AND DISABILITY PLAN plan

UNIVERSITY SETTLEMENT OF NEW YORK LIFE AND DISABILITY PLAN 401k Plan overview

Plan Name	UNIVERSITY SETTLEMENT OF NEW YORK LIFE AND DISABILITY PLAN
Plan identification number	501

UNIVERSITY SETTLEMENT OF NEW YORK LIFE AND DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

UNIVERSITY SETTLEMENT SOCIETY OF NEW YORK has sponsored the creation of one or more 401k plans.

Company Name: UNIVERSITY SETTLEMENT SOCIETY OF NEW YORK

Employer identification number (EIN): 135562374

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Additional information about UNIVERSITY SETTLEMENT SOCIETY OF NEW YORK

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1968-02-21

Company Identification Number: 220061

Legal Registered Office Address: 184 ELDRIDGE STREET
New York
NEW YORK
United States of America (USA)
10002

More information about UNIVERSITY SETTLEMENT SOCIETY OF NEW YORK

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UNIVERSITY SETTLEMENT OF NEW YORK LIFE AND DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 JUDITH ETIENNE 2023-07-18
501 2021-01-01 JASON CABRERA 2022-07-14
501 2020-01-01 MICHELLE GREEN 2021-07-18
501 2019-01-01 RACHEL LEVINE 2020-09-29

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-01-01	JUDITH ETIENNE	2023-07-18
501	2021-01-01	JASON CABRERA	2022-07-14
501	2020-01-01	MICHELLE GREEN	2021-07-18
501	2019-01-01	RACHEL LEVINE	2020-09-29

Plan Statistics for UNIVERSITY SETTLEMENT OF NEW YORK LIFE AND DISABILITY PLAN

401k plan membership statisitcs for UNIVERSITY SETTLEMENT OF NEW YORK LIFE AND DISABILITY PLAN

Measure Date Value
2022: UNIVERSITY SETTLEMENT OF NEW YORK LIFE AND DISABILITY PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 376
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 293
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 293
2021: UNIVERSITY SETTLEMENT OF NEW YORK LIFE AND DISABILITY PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 380
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 376
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 376
2020: UNIVERSITY SETTLEMENT OF NEW YORK LIFE AND DISABILITY PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 328
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 380
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 380
2019: UNIVERSITY SETTLEMENT OF NEW YORK LIFE AND DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 349
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 328
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 328

Measure	Date	Value
2022: UNIVERSITY SETTLEMENT OF NEW YORK LIFE AND DISABILITY PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	376
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	293
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	293
2021: UNIVERSITY SETTLEMENT OF NEW YORK LIFE AND DISABILITY PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	380
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	376
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	376
2020: UNIVERSITY SETTLEMENT OF NEW YORK LIFE AND DISABILITY PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	328
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	380
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	380
2019: UNIVERSITY SETTLEMENT OF NEW YORK LIFE AND DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	349
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	328
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	328

Form 5500 Responses for UNIVERSITY SETTLEMENT OF NEW YORK LIFE AND DISABILITY PLAN

2022: UNIVERSITY SETTLEMENT OF NEW YORK LIFE AND DISABILITY PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: UNIVERSITY SETTLEMENT OF NEW YORK LIFE AND DISABILITY PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: UNIVERSITY SETTLEMENT OF NEW YORK LIFE AND DISABILITY PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: UNIVERSITY SETTLEMENT OF NEW YORK LIFE AND DISABILITY PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	First time form 5500 has been submitted	Yes
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

71256

Policy instance

Insurance contract or identification number	71256
Number of Individuals Covered	386
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $4,188
Total amount of fees paid to insurance company	USD $10
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $12,334
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,188
Insurance broker organization code?	3
Amount paid for insurance broker fees	10
Additional information about fees paid to insurance broker	THIRD PARTY ADMINISTRATION FEES

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

53391

Policy instance

Insurance contract or identification number	53391
Number of Individuals Covered	376
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $16,908
Total amount of fees paid to insurance company	USD $75
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $62,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,908
Insurance broker organization code?	3
Amount paid for insurance broker fees	75
Additional information about fees paid to insurance broker	THIRD PARTY ADMINISTRATION FEES

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

53391

Policy instance

Insurance contract or identification number	53391
Number of Individuals Covered	380
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $20,978
Total amount of fees paid to insurance company	USD $75
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $55,775
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,978
Insurance broker organization code?	3
Amount paid for insurance broker fees	65
Additional information about fees paid to insurance broker	THIRD PARTY ADMINISTRATION FEES

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

53391

Policy instance

Insurance contract or identification number	53391
Number of Individuals Covered	328
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $14,213
Total amount of fees paid to insurance company	USD $112
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $48,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,213
Insurance broker organization code?	3
Amount paid for insurance broker fees	112
Additional information about fees paid to insurance broker	THIRD PARTY ADMINISTRATION FEES

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Company Name:	UNIVERSITY SETTLEMENT SOCIETY OF NEW YORK
Employer identification number (EIN):	135562374
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1968-02-21
Company Identification Number:	220061
Legal Registered Office Address:	184 ELDRIDGE STREET New York NEW YORK United States of America (USA) 10002